Friday, May 27, 2005

Psychiatric Committment for Sex Offenders

There are several states which allow sexual predators to be admitted involuntarily to psychiatric hospitals under civil committment laws. Unfortunately, the US Supreme Court has already upheld this practice. The American Psychiatric Association however has rightfully come out against this policy and others that blur the line between treatment and punishment, in a task force position statement.

[The diagnosis of sexual predator is based on] a vague and circular determination that an offender has a 'mental abnormality' that has led to repeat criminal behavior. Thus, these statutes have the effect of defining mental illness in terms of criminal behavior. This is a misuse of psychiatry, because legislators have used psychiatric commitment to effect nonmedical societal ends...

We were concerned that psychiatry was being used to preventively detain a class of people for whom confinement rather than treatment was the real goal.

Hospitalization, chemical castration, and other coercive or invasive measures which commonly fall under the rubric of treatment, must not become intrinsically connected to the mission of the psychiatric specialty, or mental health will lose its integrity as a profession people can rely upon for treatment.

Another problem is that psychiatric hospitalization is designed as an intervention to stabilize patients in an acutely dangerous state, not as treatment for a chronically dangerous trait. It's analogous to using steroids for asthma; it works for a short flare up, but if used for too long the side effects outweigh the benefits. In this context, we might expect sex offenders to acquire additional dependency, to learn and teach problem behaviors to acutely ill patients, and to cause many institutional difficulties for psychiatric systems not designed to care for them.

There is some evidence that psychotherapy may benefit repeat offenders, and there may be some role for coercive participation in those interventions, but that is much less invasive than confinement. Remember that the mental health field already has a long history of unholy alliance with the State in the service of conformity, and has only been attempting to extricate itself for the last 30 years with the deinstitutionalization movement. Let's not lose the ground we've gained.